Wiki Inpatient Billing

ajamieson458

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If a patient has Medicare Part A and does not have Part B but has other insurance (BCBS) and was seen in the hospital, and a specialist outside of the hospital (who has their own practice) goes and sees the patient in he hospital. The outside doctor gives the hospital billing to his office biller to bill for seeing a patient at the hospital, would that go under the patient's Medicare Part A coverage or the other insurance coverage?
 
Medicare Part A only pays inpatient facility claims. All physician claims are paid under the Part B benefit, even if the patient was in the hospital at the time, so if the patient does not have Part B, the full balance on the physician claim balance would go to the secondary payer for consideration.
 
Medicare Part covers the services of the facility or hospital (room and board, lab, xray, etc while in the facility). If the physician see the patient while in the facility, the physician would bill their services to Part B.

Medicare Part A (Hospital Insurance) covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in these facilities:
  • Acute care hospitals
  • Critical access hospitals
  • Inpatient rehabilitation facilities
  • Long-term care hospitals
 
For the situation ajamieson458 states, if the secondary plan is a commercial plan, which guidelines followed? For example, are consults codes cross-walked to initial visits because Medicare does not recognize consults, or left as consult codes because the commercial plan does?
 
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